“Behold The New City”: A Coherence Between Ancient and Modern Moral Challenges to Standards of Excellence in Health Care
Brendan Johnson, MD, MTS, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Phifer Nicholson, Duke University School of Medicine, Durham, NC; Kayal Parthiban, University of Massachusetts T.H. Chan School of Medicine, Worcester, MA; Brett McCarty, Duke University, Duke Divinity School, Durham, NC; and Chad Thompson, Baylor University, Waco, TX
Imagine a world where rich people receive specialized health care while poor people are socially invisible, where health outcomes differ dramatically depending on your social class, and where many of the poor are effectively noncitizens, denied basic social services. Cities are filled with shining buildings and public monuments, yet countless are sick and alone, ostracized from family and friends and the public’s collective social consciousness. Even those in health care who ostensibly have committed to care for the sick largely fail to even acknowledge those upon whom disease and disability disproportionately fall.
We are living in such a world. Medical centers fill cities with gleaming towers of progress while the poor suffer. Excellence is connected to successful outcomes for the wealthy, as marked by research dollars, specialized care, and U.S. News & World Report rankings. But we are not the first generation to find ourselves in such a disparate world.
Over 1600 years ago, the ancient Mediterranean world pursued excellence as defined by the social commitment of the citizens of cities whose glory was displayed in marble monuments. Marginalized persons – often lower-class noncitizens – did not register in the Greco-Roman moral imaginary. Professional health care was reserved for people of financial means, who enjoyed access to a variety of goods (quality food, sanitary living conditions, etc.) often inaccessible to those on the margins of society.
That world experienced a moral revolution. “Go forth a little from this city and behold the new city” (Gregory of Nazianzus). So Gregory of Nazianzus contrasted the complex institution of care created by his friend, Basil, with the fading glory of Greco-Roman Caesarea. Basil’s creation included “facilities for the sick, a hospice for lepers, a poorhouse for the indigent and elderly, and a hostel for travelers and the homeless” (Andrew Crislip), and in it we see how a transforming social imaginary intersected with the world of health care. Eventually known after its founder as the Basileias, this institution included the first ancient hospital. Unlike medical facilities for slaves and soldiers (valetudinaria), the Basileias was open to all; unlike Greco-Roman religious healing temples devoted to Asclepius, it included trained medical practitioners.
In this essay we explore how such a revolution in the 4th and 5th centuries CE took shape within health care, and point to how this historical example can reimagine and revolutionize our current conceptions of excellence in health care. In doing so, we draw from the modern example of Paul Farmer’s theo-praxical embrace of liberation theology in his lifelong contribution to global health equity. Here, too, there was a re-imagining of what is truly excellent--instead of pursuing rankings or prestige, the true standard of excellence was measured by pragmatic solidarity alongside the world’s poor. In setting these historical examples in conversation, we aim to establish a coherence between them that can inspire a similar re-conceptualization of excellence in health care.
We are living in such a world. Medical centers fill cities with gleaming towers of progress while the poor suffer. Excellence is connected to successful outcomes for the wealthy, as marked by research dollars, specialized care, and U.S. News & World Report rankings. But we are not the first generation to find ourselves in such a disparate world.
Over 1600 years ago, the ancient Mediterranean world pursued excellence as defined by the social commitment of the citizens of cities whose glory was displayed in marble monuments. Marginalized persons – often lower-class noncitizens – did not register in the Greco-Roman moral imaginary. Professional health care was reserved for people of financial means, who enjoyed access to a variety of goods (quality food, sanitary living conditions, etc.) often inaccessible to those on the margins of society.
That world experienced a moral revolution. “Go forth a little from this city and behold the new city” (Gregory of Nazianzus). So Gregory of Nazianzus contrasted the complex institution of care created by his friend, Basil, with the fading glory of Greco-Roman Caesarea. Basil’s creation included “facilities for the sick, a hospice for lepers, a poorhouse for the indigent and elderly, and a hostel for travelers and the homeless” (Andrew Crislip), and in it we see how a transforming social imaginary intersected with the world of health care. Eventually known after its founder as the Basileias, this institution included the first ancient hospital. Unlike medical facilities for slaves and soldiers (valetudinaria), the Basileias was open to all; unlike Greco-Roman religious healing temples devoted to Asclepius, it included trained medical practitioners.
In this essay we explore how such a revolution in the 4th and 5th centuries CE took shape within health care, and point to how this historical example can reimagine and revolutionize our current conceptions of excellence in health care. In doing so, we draw from the modern example of Paul Farmer’s theo-praxical embrace of liberation theology in his lifelong contribution to global health equity. Here, too, there was a re-imagining of what is truly excellent--instead of pursuing rankings or prestige, the true standard of excellence was measured by pragmatic solidarity alongside the world’s poor. In setting these historical examples in conversation, we aim to establish a coherence between them that can inspire a similar re-conceptualization of excellence in health care.